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Medically unexplained visual loss in adult patients

Griffiths, Philip Ga; Ali, Nadeemb

doi: 10.1097/WCO.0b013e32831db29c
Neuro-ophthalmology and neuro-otology: Edited by James Acheson

Purpose of review In this review, we discuss the investigation and management of patients with visual loss that cannot be accounted for by organic pathology.

Recent findings Because visual loss in these patients often has a psychosocial basis, we do not like the term ‘medically unexplained visual loss’ as a diagnostic label. ‘Unexplained visual loss’ is a useful working diagnosis until occult pathology is excluded and a positive diagnosis of functional visual loss (FVL) can be established. Recent literature highlights the utility and limitations of visually evoked potentials in estimating objective visual acuity. Multifocal electroretinography and ocular coherence tomography are invaluable in revealing occult macular pathology that may not be apparent to clinical examination and full-field electroretinography testing. Cortical visual loss can be mistaken for FVL. There is still no evidence base to guide our management of patients with FVL. However, useful insights can be gained from the literature on functional symptoms in other specialties.

Summary Making the diagnosis of FVL demands vigilance but is important to do. It should mark not just the end of investigation, but the start of treatment. More research is needed to see if treatments used in other functional disorders work in FVL.

aRoyal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK

bThe National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

Correspondence to Philip G. Griffiths, FRCophth, Consultant Ophthalmologist and Honorary Senior Lecturer, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK Tel: +44 191 2825447; fax: +44 191 2825446; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.